Reports to: Operations Supervisor
Location: 5301 Idlewild Ave, Tampa FL 33634
Responsible for accurately researching and responding to Provider Check Tracer, Returned Check, OTC Member Reimbursement and Medical Member Reimbursement inquiries for all lines of business.
Additional Responsibilities:Candidate Education:
- Research the provider/member reimbursement inquiry to determine if replacement payment/reimbursement is warranted.
- Ensure vendor and member address data is accurately reflected in our system.
- Identify root cause of each inquiry and partner with appropriate party (provider, member, configuration, market etc.) to ensure issue resolution for all work types.
- Process OTC Member Reimbursement requests timely and accurately.
- Submit manual check requests to Accounts Payable.
- Actively track and follow up on all assigned inquiries using all available tools and resources.
- Maintain department standards for production, accuracy and quality.
- Assists with other projects and duties as assigned.
- Required A High School or GED
- Required 1 year of experience in Claims processing or general healthcare background. Internal candidates must also meet key performance metrics.
- Preferred 1 year of experience in Billing, Banking, Accounting, Pharmacy and/or Appeals background
Licenses and Certifications:
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Ability to work in a matrixed environment
- Intermediate Ability to work independently
- Intermediate Ability to work as part of a team
A license in one of the following is required:
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Required Intermediate Other data entry skills